Ariz. Admin. Code § R9-24-203 - Primary Care Index

A. Every 24 months, the Department shall prepare, according to this Section, a primary care index for designating primary care areas determined under R9-24-204 as Arizona medically underserved areas.

1. For each primary care area determined under R9-24-204, the Department shall calculate the value for each criterion in subsection (B).

a. After calculating the value for each criterion in subsection (B), the Department shall assign points to each value according to Table 2.1.

b. A primary care area's score is the sum of the points received by the primary care area for each criterion in subsection (B).

2. The Department shall designate as Arizona medically underserved:

a. The primary care areas that, according to subsection (B) and Table 2.1 score within the top 25 percent on the primary care index or that obtain more than 30 points, whichever results in the designation of more Arizona medically underserved areas; and

b. The primary care areas with the designation described in R9-24-202(1).

B. For each primary care area determined by the Department under R9-24-204, the primary care index shall include a score for each of the following:

1. Population-to-primarycare- physician ratio, determined by dividing the population of the primary care area by the number of primary care physicians in the primary care area:

a. Using primary care physician data from the Arizona Medical Board and the Board of Osteopathic Examiners in Medicine and Surgery,

b. The Department shall determine an equivalency for a full-time physician where 40 hours equals 1 and 20 hours equal 0.5.

c. If the Department determines that a physician, physician assistant, or registered nurse practitioner practices less than fulltime in the primary care area, lowering the number obtained under subsection (B)(1)(b) as follows:

i. Creating a fraction with a numerator that represents the number of hours per week the physician, physician assistant, or registered nurse practitioner practices in the primary care area and with a denominator of 40;

ii. Multiplying 1.0 or 0.8, whichever is appropriate, by the fraction obtained under subsection (B)(1)(c)(i);

iii. Subtracting the result obtained under subsection (B)(1)(c)(ii) from 1.0 or 0.8, whichever is appropriate; and

iv. Subtracting the result obtained under subsection (B)(1)(c)(iii) from the number obtained under subsection (B)(1)(b);

2. Travel distance to the nearest primary care physician, determined by:

a. Estimating the distance in miles:

i. From the center of the most densely populated area in the primary care area determined from the most recent American Community Survey prepared by the U.S. Census Bureau; and

ii. To the nearest primary care physician determined from the data described in subsection (B)(1)(a); and

b. Using the most direct street route;

3. Percentage of population with calendar year income less than 200% of the Federal poverty level, determined from data in the most recent American Community Survey prepared by the U.S. Census Bureau;

a. Compiling data on the following six indicators from the most recent decennial census prepared by the U.S. Census Bureau:

i. Percentage of population with calendar year income less than 100 percent of the poverty threshold;

ii. Percentage of population older than age 65;

iii. Percentage of population younger than age 14;

iv. Percentage of population with a work disability, mobility limitation, or self-care limitation;

v. Percentage of population without a motor vehicle; and

vi. The motor-vehicle-to-population ratio;

b. Calculating the statewide average value for each of the six indicators in subsection (B)(3)(a);

c. Dividing the value of each indicator for each primary care area by the statewide average value for that indicator;

d. Multiplying the figure calculated under subsection (B)(3)(c) for each indicator by 100; and

e. Averaging the six indicator values obtained under subsection (B)(3)(d) for each primary care area;

4. Percentage of population with calendar year income less than 200% of the poverty threshold, determined from data in the most recent decennial census prepared by the U.S. Census Bureau;

5. Percentage of population with annual income between 100% and 200% of the poverty threshold, determined from data in the most recent decennial census prepared by the U.S. Census Bureau;

6. Percentage of uninsured births, determined from Department birth records reporting payment source as "self-pay" or "unknown;"

7. Ambulatory care sensitive condition hospital admissions:

a. Based on the number of hospital admissions for ambulatory care sensitive conditions per 1000 individuals living in the primary care area who are under age 65, and

b. Determined from hospital inpatient and emergency department services data provided by the Department;

8. Percentage of low-weight births, determined from data provided by the Department;

9. From data provided by the Department, the sum of the percentage of births for which the mothers reported:

a. No prenatal care,

b. Prenatal care that began in the second or third trimester, and

c. Four or fewer prenatal care visits;

10. Percentage of deaths at ages younger than the birth life expectancy, determined from the most recent U.S. life expectancy data and data provided by the Department;

11. Number of infant deaths per 1000 live births, determined from data provided by the Department;

12. Supplementary criteria score, based on the presence or absence in a primary care area of the following:

a. Percentage of minority population greater than the statewide average for all counties, determined from data in the most recent Population Estimates for Arizona's Counties, Incorporated Places and Balance of County identified in R9-24-201(28)(b) and from data in the most recent decennial census;

b. Percentage of elderly population greater than the statewide average for all counties, determined from data in the most recent Population Estimates for Arizona's Counties, Incorporated Places and Balance of County identified in R9-24-201(28)(b) and from data in the most recent decennial census; and

c. Average annual unemployment rate greater than the average annual statewide rate, from data in the most recent Arizona Unemployment Statistics Program Special Unemployment Report, prepared by the Arizona Department of Economic Security; Research Administration, in cooperation with the U.S. Department of Labor, Bureau of Labor Statistics, and available at http://www.workforce.az.gov; and

13. Sole provider or no provider score:

a. Based on whether a primary care area has only 1.0 or less than 1.0 primary care provider;

b. Counting a full-time physician as 1.0, a full-time physician assistant as 0.8, and a full-time registered nurse practitioner as 0.8; and

c. If the Department determines that a physician, physician assistant, or registered nurse practitioner practices less than fulltime in the primary care area, lowering the number obtained under subsection (B)(13)(b) as follows:

i. Creating a fraction with a numerator that represents the number of hours per week the physician, physician assistant, or registered nurse practitioner practices in the primary care area and with a denominator of 40;

ii. Multiplying 1.0 or 0.8, whichever is appropriate, by the fraction obtained under subsection (B)(13)(c)(i);

iii. Subtracting the result obtained under subsection (B)(13)(c)(ii) from 1.0 or 0.8, whichever is appropriate; and

iv. Subtracting the result obtained under subsection (B)(13)(c)(iii) from the number obtained under subsection (B)(13)(b).

C. Every 12 months, according to subsections (A) and (B) and Table 1, the Department shall:

1. Withdraw an Arizona medically underserved area designation,

2. Continue an Arizona medically underserved area designation, or

3. Designate a new Arizona medically underserved area.

D. A list of current Arizona medically underserved areas is available in the Department's annual Arizona Medically Underserved Areas (AzMUA) Report at http://www.azdhs.gov/hsd/.

4. Percentage of population who do not have health insurance as determined by the most recent American Community Survey prepared by the U.S. Census Bureau;

5. Low birthweight rate percent of births;

6. Late or no prenatal care percent of births;

7. Infant mortality rate per 1,000 live births;

8. Supplementary criteria score, based on a rate greater than the state wide average for:

a. Percentage of population age 65 and older;

b. Percentage of population age 14 and younger;

c. Percentage of population with a disability;

d. Percentage of communities of color; and

e. Percentage of population who speaks a language other than English.

C. Every 24 months, according to subsections (A) and (B) and Table 2.1, the Department shall:

1. Withdraw an Arizona medically underserved area designation,

2. Continue an Arizona medically underserved area designation, or

3. Designate a new Arizona medically underserved area.

D. A list of current Arizona medically underserved areas is available in the Department's biennial Arizona Medically Underserved Areas Report at http://www.azdhs.gov/hsd/.

Notes

Ariz. Admin. Code § R9-24-203

Adopted effective July 27, 1978 (Supp. 78-4). R9-24-203 recodified from R9-24-123 (Supp. 95-2). Section repealed; new Section adopted by final rulemaking at 7 A.A.R. 715, effective January 17, 2001 (Supp. 01-1). Amended by final rulemaking at 12 A.A.R. 3048, effective September 30, 2006 (Supp. 06-3). Amended by final expedited rulemaking at 26 A.A.R. 1969, effective 9/4/2020.